Failure of continuous cardiac output measurement using the PiCCO Device during induced hypothermia: a case report

Continuous cardiac output measurement using pulse contour analysis is a technique gaining widespread acceptance in intensive care units. We report a case where a pulse contour analysis computer (PiCCO, Pulsion Medical Systems, Munich, Germany) failed to calibrate in a patient who was undergoing induced hypothermia for anoxic brain injury. Despite several attempts to calibrate, using increased cold injectate volumes and exchanging both the PiCCO device and the arterial catheter, we were unable to correct the calibration problem and hence were unable to monitor cardiac output. Subsequent rewarming of the patient allowed calibration of the arterial waveform and continuous cardiac output measurement. We were unable to find any previous reports of this problem using a PiCCO device, although similar problems with thermodilution cardiac output estimation using the pulmonary artery catheter during hypothermic cardiopulmonary bypass have been documented.